Medial Collateral Ligament (MCL) repair or reconstruction is a surgical procedure that is used to treat the severe damage of the MCL, which is one of the most important ligaments that support the knee joint. Here’s an overview of the key aspects of MCL repair and reconstruction:Here’s an overview of the key aspects of MCL repair and reconstruction:

Indications

·        Grade III MCL Tears: These are total tears of the MCL, which results to knee instability and marked functional loss.

·        Chronic Instability: If non-surgical treatments such as wearing a brace or undergoing physiotherapy do not help in achieving stability and functionality.

·        Combined Injuries: If the MCL is injured along with other ligaments such as the ACL or the PCL that may need surgical repair.

Types of Procedures

MCL Repair

·        Primary Repair: Applicable in acute injuries where the ligament can be sutured back to the bone or sewn together. This is usually done when the ligament has been pulled off from the bone.

·        Suture Anchors: These are employed in reattaching the ligament to the bone in a stable manner.

MCL Reconstruction

·        Autograft Reconstruction: This procedure involves using the patient’s own tissue, usually from the hamstring tendons (semitendinosus and gracilis) to reconstruct the MCL.

·        Allograft Reconstruction: It involves the use of donor tissue, which is suitable for patients who may not be in a position to use their own tissue or who may not want to do so.

·        Double-Bundle Technique: Sometimes used to mimic the native anatomy of the MCL, which involves the use of two grafts to reconstruct both the superficial and deep components of the MCL.

Surgical Technique

1.     Incision: An incision is made on the medial aspect of the knee.

2.     Exposure: The MCL and all the structures around it are seen.

3.     Debridement: Any necrotic tissue is excised.

4.     Graft Preparation: If reconstruction is necessary, the graft is created by obtaining the tendon tissue (autograft) or obtaining tissue from a deceased person (allograft).

5.     Fixation: The graft is attached to the femur and tibia by screws, buttons, or anchors.

6.     Closure: The incision is closed and a sterile dressing is then put in place.

Postoperative Care

·        Immobilization: At first, the knee may be immobilized in a brace to protect the repair.

·        Physical Therapy: The process of gradual rehabilitation involves first doing range of motion exercises and then progressing to muscle strengthening exercises. The focus is on regaining the stability and the functioning of the knee joint.

·        Weight-Bearing: Non-weight bearing at first, then progressive weight-bearing as tolerated depending on the healing and stability.

Outcomes

·        Success Rates: In general, repair and reconstruction are favorable when indicated, with most patients regaining their knee stability and being able to return to their previous level of function.

·        Rehabilitation: It may take several months for a complete recovery, and a gradual resumption of sports and other high-impact activities.

Risks and Complications

·        Infection: Like any other surgery, there is always a possibility of infection.

·        Stiffness: It is also important to note that postoperative knee stiffness can develop if rehabilitation is not well coordinated.

·        Re-tear or Graft Failure: Re-injury may occur especially in the case of sportsmen who put a lot of strain on their bodies.

Conclusion

MCL repair or reconstruction is a viable solution for the management of extensive MCL injuries especially those that cause knee instability. The decision between repair and reconstruction is based on the type and time of injury, as well as the patient’s characteristics. Appropriate surgical techniques and postoperative care help the patients regain their functionality and get back to their work or other activities.